The portrayal of bariatric surgery in the UK print media.

BACKGROUND: Bariatric and metabolic surgery is a recent introduction into mainstream surgical practice. It has been shown to have a beneficial effect on the health of an individual and a positive economic impact for society. Nonetheless, bariatric surgery faces a problem of perception from both the public and healthcare commissioners. The media functions as an interface between the medical community, government and the public. It therefore plays a critical role in shaping public opinion regarding health issues. METHODS: Articles relating to bariatric surgery in the ten most frequently read UK daily newspapers were assessed over a 24-month period (January 2010-December 2011). Each article was rated via a five-point scale from very negative (1) to very positive (5) by two independent assessors to produce an average score. RESULTS: A total of 197 relevant articles were identified and analysed for content. Sixty-four (33 %) of all articles were negatively slanted (mean score 1-2.5), 105 (53 %) were positive (mean score 3.5-5) and 28 (14 %) were neutral (mean score 2.5-3.5). The average score of all articles was 3.3 (neutral, but slightly positive). CONCLUSIONS: The print media will influence public perceptions of bariatric surgery. There is huge variation in how bariatric surgery is reported, but overall the coverage is neutral. We feel that negative reportage distorts the overall awareness of bariatric surgery and may affect both how and when the obese seek medical intervention.

Subacute reaction to endoscopic mucosal resection mimicking perforation.

A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery. The exact aetiology of this patient's symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR. As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.

Pharyngeal perforation secondary to electrical shock from a Taser gun.

The case history is presented of a patient who developed pharyngeal perforation following the use of a Taser electroshock gun. This complication has not previously been reported.

Ruptured aortic aneurysm: the decision not to operate.

Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about their practices, and factors influencing the decision not to operate (no influence; may influence; seldom operate; never operate). There were 323 responses (81%) and 97% decided not to operate on selected patients. Age over 80 years influenced 77%, and 54% seldom or never operate over age 85 years. The single most influential factor was severe neurological disease (75% seldom or never operate), while cardiac, pulmonary and renal disease influenced 22%, 28%, and 21%, respectively, to operate seldom or never (74% if two or more of these). Other factors which had some influence for most surgeons were cardiac arrest (85%), loss of consciousness (74%), prolonged hypotension (73%), and long-term nursing care (87%). By contrast, factors which influenced few surgeons were haemoglobin < 9 g/dl (30%), absence of a close relative (33%), and medicolegal considerations (22%). These data help to inform the debate about case selection for repair of RAAA.

Role of preoperative localization in the management of primary hyperparathyroidism.

BACKGROUND: The advantages of preoperative localization in the management of primary hyperparathyroidism have not been clearly demonstrated. The aim of this study was to investigate prospectively the accuracy of three localization techniques in patients with this condition. METHODS: Forty-nine consecutive patients with primary hyperparathyroidism underwent ultrasonography, magnetic resonance imaging (MRI) and technetium-thallium (Tc-Tl) subtraction scanning before surgery, during which an attempt was made to identify all parathyroid glands. A scan was regarded as correct if it identified an enlarged parathyroid gland on the correct side of the neck as subsequently demonstrated at surgery. RESULTS: Ultrasonography had a sensitivity of 38 per cent (18 correct scans in 47 patients) with a positive predictive value of 78 per cent. The sensitivity of MRI was 72 per cent (34 of 47) with a predictive value of 92 per cent. Tc-Tl scanning was 60 per cent sensitive (28 of 47) with a predictive value of 85 per cent. Two patients with negative neck explorations were subsequently found to have mediastinal adenomas. CONCLUSION: Ultrasonography, MRI and Tc-Tl scanning have limited value as localization techniques and the relatively low sensitivity of these investigations means they are of no value before first-time surgery.

Plasminogen activators in oesophageal carcinoma.

The expression of components of the plasminogen activator system was investigated in patients with oesophageal carcinoma. Tumour and normal mucosa were obtained from resected oesophageal carcinomas and antigens were measured by enzyme-linked immunosorbent assay. Median levels of urokinase plasminogen activator (uPA) and the uPA receptor were higher in carcinoma than in matched normal mucosa (squamous cell carcinoma: uPA 4.05 versus 0.66 ng antigen per mg protein, uPA receptor 1.95 versus 0.50 ng/mg, n = 10, P < 0.05; adenocarcinoma: uPA 2.16 versus 0.61 ng/mg, uPA receptor 2.01 versus 0.49 ng/mg, n = 8, P < 0.05). Tissue plasminogen activator (tPA) level was lower than control values in squamous cell carcinoma but not in adenocarcinoma (1.97 versus 4.70 ng/mg, P < 0.05). There was no difference in plasminogen activator inhibitor (PAI) 1 level between carcinoma and normal mucosa. The PAI-2 level was lower than that in normals in adenocarcinoma only (6.0 versus 64.77 ng/mg, P < 0.05). These data support the hypothesis that membrane-bound uPA has a role in the breakdown of extracellular matrix in invasive oesophageal carcinoma.